I put together these medical challenges. The cases are hypothetical and do not necessarily represent actual or typical presentations of medical diseases. Disclaimer is at the bottom of this page.

Tuesday, October 4, 2016

Last Few Cases

Sorry, I was on call yesterday, and Case of the Day totally slipped my mind. Here's a pretty good one on a disease that was on critical care boards. This week is busy for me but I'll put up answers for the last few cases soon.

A patient with leukemia undergoes an autologous hematopoietic stem cell transplant. Two weeks later, she develops a temperature of 38.5C and a maculopapular rash initially concerning for graft-versus-host disease. She feels short of breath, and her room air saturation is only 84%. Review of systems is positive for diarrhea, but stool infectious workup is negative. Chest X ray shows bilateral air-space opacities. Her blood cultures, urinalysis, and sputum are negative; a procalcitonin is normal. A bronchioalveolar lavage is performed which is unremarkable. Her echo does not show heart failure though she does have some edema, weight gain, and ascites. Labs show hypoalbuminemia.

1 comment:

This is engraftment syndrome; the pulmonary component is called PERDS or peri-engraftment respiratory distress syndrome. PERDS occurs due to increased pulmonary capillary permeability during the neutrophil recovery phase of bone marrow transplant.

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